Prospective assessment of a protocol for selective ordering of preoperative chest x-rays

Routine preoperative chest x-rays are still widely employed worldwide, although results of many studies do not support their broad utilization. A protocol for selective ordering of preoperative chest x-rays, according to the patient's clinical status, medical history and scheduled surgery, was developed and implemented in a teaching hospital in Paris. The utilization of the protocol during a one-year period was evaluated. Eleven hundred and one chest x-rays were ordered in 3866 patients (28 per cent). Five hundred and sixty-eight x-rays (52 per cent) were abnormal. One hundred and sixty-six (15 per cent) were considered useful by the anaesthetists, who took into account the entire hospital course, although only 51 (5 per cent) had an impact on the surgical plan or anaesthetic management. Among the 2765 patients who did not have a preoperative chest x-ray, two patients could have benefited from the chest x-ray, in the view of anaesthetists. Chart review for these two patients and for patients who had perioperative complications in the absence of a preoperative chest x-ray revealed that no complications could be linked to the lack of preoperative chest x-ray ordering. This study shows that the abandonment of routine ordering of preoperative chest x-rays does not produce adverse effects on patient care.